本基礎研究は,高血糖時の脳虚血・再灌流負荷に対する脳内NO産生動態の解明を目的とした.雄性Wistarラットを対象に,高血糖群と対照群をそれぞれ7匹用いた.大腿動静脈にカテーテルを挿入し,血圧測定とglucose注入に用いた.一側線条体と海馬に微小透析プローブを刺入し,in vivo microdialysisを行った.脳虚血はSmithの方法に従い,前脳虚血を20分間施行した後,再灌流・血液再注入を行った.実験終了後,灌流液中のNO2-とNO3-濃度をGriess反応で測定し比較した.1.基礎NO産生:高血糖群のtotal NO(NO2-+NO3-)は対照群に比し線条体・海馬ともに高値を示した.II.虚血後NO産生:線条体における虚血10,20分後のtotal NOは高血糖群では対照群に比し高値であった.再灌流10分のNO3一は高血糖群では対照群に比し高値であった.以上より,高血糖負荷時の虚血・再灌流における線条体のNO産生増加は,高血糖による細胞傷害の一つの要因であると考えた.
Evidence-based medicine (EBM) has been emphasized in Japan for these years. In management of acute stroke, prospective stroke registries and randomized controlled trials have provided evidence that helps us examine and treat patients with acute stroke. Unfortunately evidence in stroke management has almost always been imported into Japan from the Western countries. In order to obtain reliable large-scale data on stroke management, the Japan Multicenter Stroke Investigators' Collaboration (J-MUSIC) conducted a multicenter study. A total of 16, 922 patients with acute ischemic stroke admitted to 156 hospitals within 7 days after stroke onset were prospectively registered during the study period of one year. The study clearly demonstrated age, sex, onset to arrival time, neurological deficits, stroke subtypes, length of hospital stay, and clinical outcome of the patients and the current status of acute ischemic management. The study provided results supporting potential efficacy of hyperacute local thrombolytic therapy with urokinase. In order to succeed to the fruits of the J-MUSIC study, the Japanese Standard Stroke Registration Study (JSSRS) was organized and completed a computer software for electronically collected database of acute stroke patients. The JSSRS database will be used for the nation-wide stroke registry, so-called Japan Acute Stroke Data Bank, and will help establish EBM for acute stroke in Japan.
There is only a few evidence for stroke management has been reported from Japan. It is necessary to make a data bank of acute stroke patients as infrastructure to make evidence for standardization of stroke management. We made Japan standard stroke registry study (JSSRS) supported by ministry of health and welfare from 1999 to 2002. We completed computerized registry system and accumulated about 8, 000 acute stroke cases from 45 stroke center hospitals. This system is also functioning as a stroke database for each hospital. From the analysis of the distribution of stroke subtype, the incidence of atherothrombotic infarction and cardiogenic embolism was similar to lacunar infarction as shown in Figure 1. Furthermore, the 38% of ischemic stroke patients admitted within 3 hours. Thrombolytic therapy was performed in 15% of the patients who admitted within 3 hours and their initial severity were NIHSS 6-29. The outcome of the patients treated with thrombolytic therapy was significantly better than those without it. These data indicate that the stroke data bank should be useful tool to make verification of the guideline and planning a clinical trial for EBM in near future.